Disability Law Center

Massachusetts Protection and Advocacy

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Ask For Help

Do you think you need legal help, have a question, or would you like to alert us about a potential abuse or neglect situation?

If so, please fill out the form below. Tell us about the problem or question you have. Be as detailed as possible. This information helps us to understand your needs and if we may be able to help.

Click ‘Send’ when you are done.  DLC’s Intake Team will contact you as quickly as possible.

IMPORTANT!!

DLC’s Intake Team accepts new requests for help between 9 am and 1 pm on Mondays, Tuesdays, and Wednesdays. While we do our best, we may not be able to respond to requests for help outside of these hours.

Please enable JavaScript in your browser to complete this form.

Name of individual with the disability: *

First

Last

This Online Intake Form does not create an attorney-client relationship with DLC. DLC will review your Online Intake Form to consider what help we can offer.

Telephone number of the individual with the disability: *

Email of the individual with the disability: *

Date of birth of the individual with the disability: *

Please describe the disability: *

Address of the individual with the disability: *

Address Line 1

City

State

Zip Code

What is the preferred language of the individual with the disability:

What is the language of the individual with the disability:

Problem Area:

Abuse or Neglect
Access to Durable Medical Equipment
Access to Services for SSA Beneficiaries (NOTE: DLC does not help with applications for benefits or appealing denials)
Communication Access in Healthcare Services
Human rights violations in hospitals, nursing homes, group homes etc.
Reasonable Accommodations (in housing, employment, etc.)
Voting Access
Other

Please explain the Problem Area if 'Other' was selected:

Describe the problem and how it relates to your disability. When did the problem start or incident occur? *

What would you like DLC to do? What would you like to happen? *

Describe any deadlines. What is the deadline for? When is the deadline? (You are responsible for all deadlines.)

Is there any one helping with this issue and is there an attorney involved? *

Do you have any concerns about your representative payee?

Yes
No
Not applicable

If you are not the individual with the disability, state your name:

First

Last

Phone

Email

Your relationship to the individual with the disability:

By checking this box, I agree to receive SMS content (text messages) from DLC *

I agree.
I do NOT agree.

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Disability Law Center, Inc.

11 Beacon Street, Suite 925
Boston, MA 02108
617 723-8455 | 800 872-9992
mail@dlc-ma.org

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National Disability Rights Network

Massachusetts Legal Services

The information on this website is not offered as legal advice and should not be used as a substitute for seeking professional legal advice. No information on this website creates an attorney-client relationship with you. This website has been developed at U.S. taxpayer expense.